The covid-19 epidemic was declared a Public Health Emergency of International Concern (PHEIC) by the WHO on Thursday 30th January, 2020. By 11th March the World Health Organization had already officially defined it as a pandemic. That day, more than 118,000 cases were documented in 114 countries and 4,291 people lost their lives to this disease. The rest of the story is already known by the entire world.

From that moment on, the expectation of recovering from covid-19 was based on at least 70% of the general population being vaccinated as soon as possible. Although the vaccine was developed in record time, the worldwide production and distribution became the major bottlenecks waiting to be solved.

The first person in the western hemisphere to be vaccinated against the SARS-CoV-2 virus was a 90-year-old woman in Northern Ireland, United Kingdom back on 8th December, 2020. In Costa Rica, vaccinations officially began on Christmas Eve (24th December 2020), with a 91-year-old woman being the first person to receive the vaccine.

In Costa Rica, the National Emergency Commission (CNE) declared a ‘Green Alert’ on 6th January 2020, two months before the first covid-19 case arrived in the country, on 6th March. By 30th May 2022, at least 86.1% of the total population had received at least one vaccine dose, 80.5% had received the full scheme of two doses, 45.1% were boosted, and 3.4% were double boosted.

Almost 70% of these vaccines were acquired by the country either directly through contracts with pharmaceutical companies or under the WHO’s Covax program. The remaining approximately 30% of those vaccines were donated by governments of friendly countries or other international actors who based their decision on criteria of ‘effective solidarity’.

International effective solidarity

The covid-19 pandemic that is affecting us globally is an opportunity we must use to demonstrate the solidarity of humanity. Many nations that had the mechanisms and financial resources to do so have negotiated sufficient contracts with the pharmaceutical industry, which allowed them to have plenty of supplies against covid-19 after having vaccinated a high percentage of their population. The rest of the nations could not get enough vaccines to be used in time; therefore, they urgently needed to receive more surpluses from other countries.

There are international mechanisms specially designed to distribute the covid-19 vaccine in an equitable manner. One example of these international mechanisms is Covax, another example is the one emphasized in voluntary sharing of technology like the WHO C-TAP option. Many of these mechanisms have had a very slow response in some of the countries when it comes to providing surpluses and expressing their interest in sharing them as soon as possible and in a direct way. The mechanisms that distribute these surpluses must consider the needs of the receiving nations and their capacity to use the vaccines effectively, otherwise there is a risk that large amounts of vaccine lots are delivered to governments that are not capable of using them in a timely manner, so they end up wasted in the process.

We must apply criteria of effective solidarity when distributing surpluses of covid-19 vaccines. This implies it is essential to prevent corruption, to identify health systems incapable of using them or maintaining the rigorous technical logistics, and to maintain a cold chain guarantee that these products require according to each manufacturer. We cannot forget that pharmaceutical products have an expiration date after which they become denatured and must be discarded.

This effective solidarity is based on good international epidemiological practices, the application of the principles of ‘triage for disaster’, and emergency management; therefore, this concept should not solely consider the need for vaccines that a country may have when it is applied.

Fighting the covid-19 pandemic is a matter of national, regional and global security. Countries that achieve high levels of immunization of their population on their own will not be safe until their neighboring countries and the rest of the world achieve those levels of immunization as well. We must create immunization ‘bags or sacks’.

Another mandatory principle that must be considered is the one used in emergency situations that applies the principles of triage in disaster areas. When there is an extreme situation relating to world health, time is precious. When lives are lost due to the coronavirus, time means lives saved, thus even scarce resources must be redirected to help the victims. In a disaster zone, the victims who are most likely to survive are always treated first and then the victims with the worst prognosis are treated later.

Another disaster management criteria seeks to prevent the victims from worsening or increasing once the disaster has occurred. These criteria indicate that we must apply the best to cope with an extreme situation. We must first stay safe, before dedicating ourselves to save the rest. We applied this principle every day when we first got health personnel vaccinated in such a way that we had enough health professionals to be able to keep healthcare systems running and thus save more lives.

An example easy to understand is when traveling by plane; if the cabin is depressurized and oxygen masks fall for passengers and crew, it is recommended that the crew put them on before helping the most vulnerable ones. Similarly, adults should put on their masks first before helping children. When it comes to timely disaster management, do what you can to prevent things from getting worse. There is evidence that we must keep ourselves safe first to survive, otherwise the final death toll will be much higher.

More countries should raise their vaccination rate to the top of the most vaccinated nations list, with this action they will contribute to the efforts that are being made. Increasing the vaccination rate will help countries that do not have the logistics and capabilities to obtain more vaccines. It takes many months to train health personnel, equip freezers, technical and security mechanisms so that the vaccines given to them will have certain minimum guarantees that they will be used properly. Time is always short when facing disasters.

Opportunities will come to debate why the inequality gaps in this world are widening and how it is possible that during this pandemic these inequities grew wildly, costing us so many lives that should be classified as avoidable mortality. This is the time to act, and to do it with effective solidarity.

Vaccine doses for Costa Rica

With a population of 5.2 million inhabitants, a solid institutional framework and a hundred-year-old health sector, Costa Rica is a country that made the decision to approve the use of medical devices, health products and pharmaceuticals, that meet the most demanding standards of good development and registration practices at the international level. In Costa Rica, you can only purchase or accept donations of vaccines and health products in general that meet this requirement.

The first step was easy, showing that our health system could take advantage of specific donations, safely meeting the technical requirements of the cold chain, and others, for even the most demanding brands. In addition, that we maintain sufficient human capital and administrative controls to avoid the abuses and corruption usually associated with these type of donations. Back then, the CMO of the Costa Rican Social Security Fund was Dr. Mario Ruiz Cubillo. And finally, that we maintain universal coverage as a reality that has been accompanying us for decades, which guarantees that both nationals and foreigners were timely vaccinated.

The next step was to deploy diplomacy through the foreign service to obtain the necessary international cooperation to accelerate the availability of vaccines for our population. Costa Rica obtained sufficient donations and deliveries to be able to maintain a consistent rate of vaccination throughout the country in the following way.

Under the coordination of the Vice Minister, Adriana Bolaños Argueta, sufficient diplomatic efforts were made so that by 21st March 2022, the country had already received a cumulative 3,733,790 doses of vaccines donated from the governments of Spain (1,572,290), the United States (1,503,900), Canada (319,200), France (200,070), the Dominican Republic (56,800), Austria (50,000) and even the same from the companies AstraZeneca and Pfizer/BioNTech. These were added to the 7,880,935 doses per purchase contract, and Costa Rica was one of the countries capable of keeping the vaccination strategy underway, throughout the national territory, both for nationals and foreigners living in the country, with a large general stock of 11,614,725 doses of vaccines.

Thanks to this international effective solidarity, Costa Rica's advanced health system and the diplomatic capacity of its foreign service, today our country can offer a safer environment against covid-19 for nationals and foreigners who visit us.